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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
From:
Semin Oncol Nurs. Author manuscript; available in PMC Nov 1, 2011.
Published in final edited form as:
Semin Oncol Nurs. Nov 2010; 26(4): 266–284.
doi: 10.1016/j.soncn.2010.08.006
Table 1
National Consensus Panel Eight Domains of Quality Palliative Care and Corresponding National Quality Forum Preferred Practices ([BOLDED] ENTRIES REFER TO CORRESPONDING DOMAIN FROM – see Table 2)
NCP Domains of Quality
Palliative Care
NQF Preferred Practices

1. Structure and processes of care1. Provide palliative and hospice care by an
interdisciplinary team of skilled palliative care
professionals, including, for example, physicians,
nurses, social workers, pharmacists, spiritual care
counselors, and others who collaborate with primary
healthcare professional(s). [4. STAFFING]
2. Provide access to palliative and hospice care that is
responsive to the patient and family 24 hours a day, 7
days a week. [3. AVAILABILITY]
3. Provide continuing education to all healthcare
professionals on the domains of palliative care and
hospice care. [8. EDUCATION]
4. Provide adequate training and clinical support to
assure that professional staff are confident in their
ability to provide palliative care for patients.
[12. STAFF WELLNESS]
5. Hospice care and specialized palliative care
professionals should be appropriately trained,
credentialed, and/or certified in their area of expertise.
[4. STAFFING]
6. Formulate, utilize, and regularly review a timely care
plan based on a comprehensive interdisciplinary
assessment of the values, preferences, goals, and
needs of the patient and family and, to the extent that
existing privacy laws permit, ensure that the plan is
broadly disseminated, both internally and externally, to
all professionals involved in the patient’s care.
7. Ensure that upon transfer between healthcare
settings, there is timely and thorough communication of
the patient’s goals, preferences, values, and clinical
information so that continuity of care and seamless
follow-up are assured.[11. CONTINUITY OF CARE]
8. Healthcare professionals should present hospice as
an option to all patients and families when death within
a year would not be surprising and should reintroduce
the hospice option as the patient declines. [11.
CONTINUITY OF CARE]
9. Patients and caregivers should be asked by
palliative and hospice care programs to assess
physicians’/healthcare professionals’ ability to discuss
hospice as an option.
10. Enable patients to make informed decisions about
their care by educating them on the process of their
disease, prognosis, and the benefits and burdens of
potential interventions.
11. Provide education and support to families and
unlicensed caregivers based on the patient’s
individualized care plan to assure safe and appropriate
care for the patient.

2. Physical aspects of care12. Measure and document pain, dyspnea,
constipation, and other symptoms using available
standardized scales. [5. MEASUREMENT & 6. QI ]
13. Assess and manage symptoms and side effects in
a timely, safe, and effective manner to a level that is
acceptable to the patient and family.
[5. MEASUREMENT & 6. QI ]

3. Psychological and psychiatric aspects of care14. Measure and document anxiety, depression,
delirium, behavioral disturbances, and other common
psychological symptoms using available standardized
scales. [5. MEASUREMENT & 6. QI ]
15. Manage anxiety, depression, delirium, behavioral
disturbances, and other common psychological
symptoms in a timely, safe, and effective manner to a
level that is acceptable to the patient and family. [5.
MEASUREMENT & 6. QI ]
16. Assess and manage the psychological reactions of
patients and families (including stress, anticipatory
grief, and coping) in a regular, ongoing fashion in order
to address emotional and functional impairment and
loss. [5. MEASUREMENT & 6. QI ]
17. Develop and offer a grief and bereavement care
plan to provide services to patients and families prior to
and for at least 13 months after the death of the
patient. [9. BEREAVEMENT]

4. Social aspects of care18. Conduct regular patient and family care
conferences with physicians and other appropriate
members of the interdisciplinary team to provide
information, to discuss goals of care, disease
prognosis, and advance care planning, and to offer
support.
19. Develop and implement a comprehensive social
care plan that addresses the social, practical, and legal
needs of the patient and caregivers, including but not
limited to relationships, communication, existing social
and cultural networks, decision-making, work and
school settings, finances, sexuality/intimacy, caregiver
availability/stress, and access to medicines and
equipment. [4. STAFFING]

5. Spiritual, religious, and
existential aspects of care
20. Develop and document a plan based on an
assessment of religious, spiritual, and existential
concerns using a structured instrument, and integrate
the information obtained from the assessment into the
palliative care plan. [4. STAFFING]
21. Provide information about the availability of spiritual
care services, and make spiritual care available either
through organizational spiritual care counseling or
through the patient’s own clergy relationships.
[4. STAFFING]
22. Specialized palliative and hospice care teams
should include spiritual care professionals appropriately
trained and certified in palliative care. [4. STAFFING]
23. Specialized palliative and hospice spiritual care
professionals should build partnerships with community
clergy and provide education and counseling related to
end-of-life care. [4. STAFFING]

6. Cultural aspects of care24. Incorporate cultural assessment as a component of
comprehensive palliative and hospice care
assessment, including but not limited to locus of
decision-making, preferences regarding disclosure of
information, truth telling and decision-making, dietary
preferences, language, family communication, desire
for support measures such as palliative therapies and
complementary and alternative medicine, perspectives
on death, suffering, and grieving, and funeral/burial
rituals.

7. Care of the imminently dying
patient
26. Recognize and document the transition to the
active dying phase, and communicate to the patient,
family, and staff the expectation of imminent death.
27. Educate the family on a timely basis regarding the
signs and symptoms of imminent death in an age-
appropriate, developmentally appropriate, and
culturally appropriate manner.
28. As part of the ongoing care planning process,
routinely ascertain and document patient and family
wishes about the care setting for the site of death, and
fulfill patient and family preferences when possible.
[11. CONTINUITY OF CARE]
29. Provide adequate dosage of analgesics and
sedatives as appropriate to achieve patient comfort
during the active dying phase, and address concerns
and fears about using narcotics and of analgesics
hastening death.
30. Treat the body after death with respect according to
the cultural and religious practices of the family and in
accordance with local law. [9. BEREAVEMENT
31. Facilitate effective grieving by implementing in a
timely manner a bereavement care plan after the
patient’s death, when the family remains the focus of
care. [9. BEREAVEMENT

8. Ethical and legal aspects of care32. Document the designated surrogate/decisionmaker
in accordance with state law for every patient in
primary, acute, and long-term care and in palliative and
hospice care.
33. Document the patient/surrogate preferences for
goals of care, treatment options, and setting of care at
first assessment and at frequent intervals as conditions
change.
34. Convert the patient treatment goals into medical
orders, and ensure that the information is transferable
and applicable across care settings, including long-
term care, emergency medical services, and hospital
care, through a program such as the Physician Orders
for Life-Sustaining Treatment (POLST) program.
35. Make advance directives and surrogacy
designations available across care settings, while
protecting patient privacy and adherence to HIPAA
regulations, for example, by using Internet-based
registries or electronic personal health records.
36. Develop healthcare and community collaborations
to promote advance care planning and the completion
of advance directives for all individuals, for example,
the Respecting Choices and Community Conversations
on Compassionate Care programs.
37. Establish or have access to ethics committees or
ethics consultation across care settings to address
ethical conflicts at the end of life.
38. For minors with decision-making capacity,
document the child’s views and preferences for medical
care, including assent for treatment, and give them
appropriate weight in decision-making. Make
appropriate professional staff members available to
both the child and the adult decision-maker for
consultation and intervention when the child’s wishes
differ from those of the adult decision-maker.
Data from: 10, 18, 24